Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Bobby Gene Stout Jr., PA-C

Individual provider Physician Assistant · NPI 1235128612

Mr. Bobby Gene Stout Jr., PA-C is a Physician Assistant in Lawrenceville, Georgia. Qualified in 2001, 25 years ago. Practices with Northside Cv Professional Services LLC, a 53-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Georgia.

Years since qualifying
25
Licensed in
GA
In the registry since
2005
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

2200 Medical Center Blvd Ste 350
Lawrenceville, GA 30046-7768
Phone: (678) 312-2700
Fax: (678) 312-2730
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 003770 (GA)

Record details

NPI number1235128612
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 18, 2005
Last updated in NPPESJune 4, 2025
Certification dateJune 4, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2001 (25 years in practice)
Group practice Northside Cv Professional Services Llc — 53 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations5 on file with Medicare

Other providers in Lawrenceville